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The LA Times has an excellent piece on the various proposals that states are considering concerning health care reform. The article states,

From coast to coast, Democratic and Republican governors are pursuing divergent policies to control healthcare costs and expand access to services. In the process, they are grappling with the same basic question facing Washington: Should government attempt to reinforce the existing system under which most Americans receive health insurance as part of large groups, or tilt the nation toward an approach that shifts more control, but also more financial burden and risk, to individuals?

In tune with President Bush's agenda, GOP plans in Florida and South Carolina attempt to reduce the growth of healthcare costs by directing more of the cost away from government and private insurers and toward individuals. Republican leaders promote these plans as models to guide healthcare changes.

"One of the reasons we have a healthcare crisis is because, as a consumer, I don't have that much skin in the game," said Arkansas GOP Gov. Mike Huckabee. "A lot of us feel there needs to be a transformation from a third-party [insurance] system to more [financial] participation by the [patient]."

By contrast, Democratic proposals seek to reinforce public and employer-based healthcare systems that partly shelter individuals from medical bills. That philosophy underlies efforts in California, Illinois and New Mexico to guarantee coverage of all children — and efforts in Maryland, Wisconsin and Iowa to encourage or compel more employers to insure workers.

In these states, "We are very explicitly talking about whether we pool together to share the risk in healthcare or we devolve into a system of everybody for themselves," said Anthony Wright, head of the liberal group Health Access California, which supports a proposed ballot measure that would guarantee universal coverage for the state's children.

Thanks to Ezra Klein for this article. He also has a terrific discussion of the "no skin in the game" comment by Governor Huckabee. [bm]